Pendekatan Time-Driven Activity-Based Costing dan Theoretical Framework of Acceptability untuk Estimasi Anggaran Layanan Home-Based Palliative Care di Yogyakarta

Hariyanti, Tatik
Hafidz, Firdaus
Budiarto, Arif

Jurnal Ekonomi Kesehatan Indonesia
Vol. 11, No. 1

Palliative care services delivered through a home care scheme in Indonesia are not yet included in the National Health Insurance (JKN) benefit package. Through a bridging guarantee scheme, since 2020 the Regional Government of the Special Region of Yogyakarta (DIY) has provided this service to the local population in accordance with applicable regulations. Therefore, a basis for budget allocation that considers the regional conditions of DIY is required. This study employed a mixed-methods approach with an explanatory sequential design, beginning with a quantitative study to estimate the prevalence of the population requiring palliative care services as well as the unit cost using a time-driven activity-based costing (TDABC) approach. The qualitative study was conducted using purposive sampling of 14 respondents through in-depth interviews with healthcare workers, patients and their families, and policymakers, applying the Theoretical Framework of Acceptability (TFA). The estimated prevalence over five years (2025–2029) showed 145, 148, 151, 155, and 158 cases, respectively. The unit cost of palliative care services using the TDABC approach was IDR 3,396,787. The estimated budget for services over five years, after being multiplied by the number of cases, amounted to IDR 492,534,115; IDR 502,724,476; IDR 512,914,837; IDR 526,501,985; and IDR 536,692,346, respectively. Palliative care is a necessary service that provides significant benefits, particularly for poor and underprivileged populations. However, broader dissemination is needed, including clearer service standards and regulatory frameworks governing its implementation. Based on the financial capacity of the Regional Government of DIY, stakeholders need to prioritize eligible population groups as service beneficiaries, while also restructuring the existing service delivery system. This budget estimation is proposed as a basis for allocating funds to ensure the sustainability of palliative care services for poor and underprivileged populations in DIY.